Provider Demographics
NPI:1518907476
Name:COVENTRY, KATHLEEN KAY (MS CCCA FAAA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KAY
Last Name:COVENTRY
Suffix:
Gender:F
Credentials:MS CCCA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY WEST
Mailing Address - Street 2:STE 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3315
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:5959 GATEWAY WEST
Practice Address - Street 2:STE 160
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3315
Practice Address - Country:US
Practice Address - Phone:915-779-5866
Practice Address - Fax:915-771-6558
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51403231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist